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WO2010141292A2 - Insert d'espacement composite et support pour fournir un support vertébral intercervical - Google Patents

Insert d'espacement composite et support pour fournir un support vertébral intercervical Download PDF

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Publication number
WO2010141292A2
WO2010141292A2 PCT/US2010/036240 US2010036240W WO2010141292A2 WO 2010141292 A2 WO2010141292 A2 WO 2010141292A2 US 2010036240 W US2010036240 W US 2010036240W WO 2010141292 A2 WO2010141292 A2 WO 2010141292A2
Authority
WO
WIPO (PCT)
Prior art keywords
vertebrae
space
insert
exterior
undercut
Prior art date
Application number
PCT/US2010/036240
Other languages
English (en)
Other versions
WO2010141292A3 (fr
Inventor
Miguel A. Linares
Original Assignee
Linares Medical Devices, Llc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Linares Medical Devices, Llc filed Critical Linares Medical Devices, Llc
Publication of WO2010141292A2 publication Critical patent/WO2010141292A2/fr
Publication of WO2010141292A3 publication Critical patent/WO2010141292A3/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A61B17/7059—Cortical plates
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8085—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with pliable or malleable elements or having a mesh-like structure, e.g. small strips
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
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    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7019—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other
    • A61B17/7031—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other made wholly or partly of flexible material
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    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7043—Screws or hooks combined with longitudinal elements which do not contact vertebrae with a longitudinal element fixed to one or more transverse elements which connect multiple screws or hooks
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    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
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    • A61B2017/7073—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant with intervertebral connecting element crossing an imaginary spinal median surface
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    • A61F2/441—Joints for the spine, e.g. vertebrae, spinal discs made of inflatable pockets or chambers filled with fluid, e.g. with hydrogel
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2002/30003—Material related properties of the prosthesis or of a coating on the prosthesis
    • A61F2002/30004—Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis
    • A61F2002/30014—Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis differing in elasticity, stiffness or compressibility
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/30004—Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis
    • A61F2002/30016—Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis differing in hardness, e.g. Vickers, Shore, Brinell
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
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    • A61F2002/30537—Special structural features of bone or joint prostheses not otherwise provided for adjustable
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    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
    • A61F2002/30879—Ribs
    • A61F2002/30883—Ribs dovetail-shaped
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30904—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves serrated profile, i.e. saw-toothed
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0033—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0091—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements connected by a hinged linkage mechanism, e.g. of the single-bar or multi-bar linkage type
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0004—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable
    • A61F2250/0006—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable for adjusting angular orientation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0014—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis
    • A61F2250/0018—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in elasticity, stiffness or compressibility
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0014—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis
    • A61F2250/0019—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in hardness, e.g. Vickers, Shore, Brinell

Definitions

  • the present invention relates generally to inter- vertebral support braces. More specifically, the present invention discloses a combined spacer insert with or without support web for use in either or both inter-vertebral supporting and/or replacement of one ore more cervical spinal vertebrae.
  • a combination spacer insert and support for incorporating into a spacing or cavity (which for purposes of this description is interpreted to include any type of enclosed space according to any dimension or configuration and which is established between inter- spinal vertebrae) defined between a spaced apart pair of vertebrae.
  • a first insert body is constructed of a composite material exhibiting at least one modulus of elasticity with a substantially cylindrical shape and is inserted within the cavity location, such as established between a pair of previously non-consecutive vertebrae and corresponding in location to a further previously damaged or removed vertebrae.
  • the insert body may further exhibit first and second laterally or height displaceable portions.
  • the insert body is further constructed of a composite plastic material including first and second plastic subset components exhibiting separate first and second modulus of elasticity.
  • the composite plastic material may further be admixed with at least one of a metal, a ceramic and an anti-microbial material.
  • An additional and exterior supported member engages locations associated with the (formerly) non-consecutive vertebrae and which, in combination with the insert body, provides a limited degree of mobility to the vertebrae.
  • the exterior supported member may further include a semi-rigid plastic with undercut engaging portions associated with first and second ends of the member. The ends can further be elastically deformable.
  • the insert body and exterior supported member may further be combined into a unitary component, such as further incorporating a flexible membrane supported upon a conical and apertured spine portion extending from a vertebral surface mounted end plug.
  • Barbed anchors are provided for seating within the end plug and mounting within undercut patterns formed within the spaced apart vertebrae.
  • a syringe is injected and a settable liquid introduced for inflating the membrane within the cavity and into supporting fashion with the vertebrae.
  • FIG. 1 is a plan illustration of a first configuration according to the present inventions and which illustrates the provision of a spacer insert installed within a space previously occupied by a removed vertebrae, in combination with an exterior secured strap or support exhibiting angled contact feet for engaging within undercut locations formed within each of first and second pairs of succeeding vertebrae located above and below the insert;
  • Fig. 2 is an illustration of a further configuration of exterior bracing strap exhibiting bulbous end projecting and undercut location engaging feet defined in vertebrae located on either side of an installed spacer insert;
  • FIG. 3 is a rotated plan view of a further strap configuration and illustrating the use of multiple engaging locations for securing the strap to the adjoining vertebrae;
  • Fig. 4 illustrates a further modified strap configuration in which the spacer insert is surrounded by a plurality of individual and thin cross sectional straps arranged in a circumferential cage extending fashion;
  • Fig. 4A is an enlarged partial view of an end-engaging location associated with a selected strap in Fig.
  • FIG. 5 is an illustration of a related spacer and strap configuration and illustrating a modified fastener engagement configuration for securing the strap at first and second vertebrae boundary locations;
  • FIG. 6 is a perspective illustration of another variant in which a pair of spacer inserts are provided along with a further configuration of exterior mounting supports for engaging upper and lower adjoining vertebrae;
  • FIG. 7 is another illustration of a dual spacer insert arrangement in combination with a widened and exterior supporting strap
  • FIG. 8A is an illustration of a key engageable and outwardly expandable insert according to a further variant
  • Fig. 8B is an alternately configured insert to that shown in Fig. 8 A and again exhibiting end surface undercut patterns for promoting bone adhesion and growth when installed between succeeding vertebrae;
  • FIG. 8C is an illustration of another configuration of a key accessible and expandable insert exhibiting laterally expandable wing portions in combination with fusion/growth promoting end surface undercut patterns;
  • Fig. 8D is a top view of an insert according to another variant
  • Fig. 8E is perspective view of the insert shown in Fig. 8D and illustrating the feature of edge extending and engaging tabs for mounting the spacer to an existing and succeeding vertebrae;
  • Fig. 9 is a plan view illustration of a pair of exterior mounting members in combination with an insert spacer according to a yet further embodiment;
  • FIG. 9A is an enlarged partial illustration showing a configuration of a selected undercut engaging portion associated with an exterior mounting member
  • FIG. 9B is an illustration of a mounting member exhibiting flexural joint locations proximate end disposed and inter-vertebral space engaging portions associated with the mounting member;
  • FIG. 10 is an illustration of another elongate mounting member also including the features of flexural promoting joints defined within the member at locations proximate inter- vertebral space engaging portions, in combination with screws extending through end locations of the member;
  • FIG. 11 is an illustration of another design of flexural supporting strap extending between spaced apart vertebrae and across a substitute insert spacer according to a further embodiment
  • Fig. 12 is a rotated illustration of the supporting strap shown in Fig. 11 and illustrating both lineal end extending portions as well as inwardly extending and inter vertebral engaging portions;
  • FIG. 13 is a side plan view in exploded fashion and illustrating an artificial disc replacement mechanism according to a still further preferred embodiment exhibiting a hollowed out area corresponding to a previously prepared location including rear disc located support and front undercut defined support locations, and within which is installed a balloon jack with forward sealing plug;
  • Fig. 14 is a succeeding an intermediate assembled illustration showing the balloon jack inserted within the prepared disc area, such that an apertured and conical shaped spine supports an inside of the bladder within the apertured area, and at which angled barb anchors associated with the outer plug are displaced into aligning undercuts defined in upper and lower opposing locations associated with upper/lower succeeding vertebrae;
  • Fig. 14A is an enlarged inset view taken from Fig. 14 and better illustrating the engagement of the angled barb anchors projecting from the plug with the aligning undercuts formed in the spatially opposing vertebrae;
  • Fig. 14B is a perspective view of the insertable jack illustrated in each of Figs. 14 and 14A and again showing the end plug and conical spine shaped support;
  • FIG. 15 is a further succeeding illustration in which a syringe charged with a settable fluidic material is injected through the plug, through the apertures associated with the conical spine and in order to expand the bladder to abut the front and rear locations of the vertebral defined space and to bias against the upper and lower adjoining vertebrae;
  • Fig. 16 is a rotated front view of the disc replacement mechanism and illustrating first and second pairs of angularly displaceable/engageable anchors combined with a central injection aperture;
  • Fig. 17 is a top view cutaway illustration taken along line 17-17 of Fig. 16 and further illustrating the operational configuration of the disc replacement mechanism.
  • the present invention discloses a variety of combined spacer inserts, with or without support webs, straps or other interior or exterior secured members, for use in either or both inter-vertebral supporting and/or replacement of one ore more spinal vertebrae, and which includes but is not limited to cervical vertebrae as well as thoracic and lower lumbar vertebrae.
  • the present invention is further an improvement over prior art titanium plates and screws which fixedly anchor vertebrae.
  • Figure 1 is a plan illustration of a first configuration according to the present inventions and which illustrates the provision of a spacer insert 10 installed within a space previously occupied by a removed vertebrae (and which is again collectively understood to include any of a hole, cavity or the like which is generally defined as any enclosed space or configuration established between individual vertebrae).
  • an exterior secured and generally elongated structurally supporting member 12 is provided (this further understood for purposes of each of the succeeding variants to include a generally structurally supporting strap or semi-rigid member having a desired length for interconnecting spaced apart vertebrae) and exhibits angled end located contact feet (see as further shown at 14/16 at an upper extending end and further at 18/20 for a lower extending end) for engaging within undercut defined locations formed within each of first 2/4 and second 6/8 pairs of succeeding vertebrae located at spaced distances both above and below the insert 10.
  • both the three dimensional and generally cylindrical shaped insert 10 and exterior elongated and structurally supporting member 12 are constructed of any of a unitary plastic, combination hard/soft plastic or composite plastic (such as further incorporating metal and/or ceramic subset admixtures). Additionally, each of the inner supported body (or insert) 10 and exterior extending and supported member 12 (as further depicted in succeeding variants described in each of Figs.
  • 2, 3, 4, 5, 6, 7, 9, 10, 11 and 12 include a specified bending or elastic modulus of elasticity (in the further instance of the insert 10 optionally including outer and inner varying modulii) and so as to provide desired performance and flexural properties.
  • a specified bending or elastic modulus of elasticity in the further instance of the insert 10 optionally including outer and inner varying modulii
  • Such includes the desire of the assembly to provide adequate support to the spinal column to prevent pinching or damage to the spinal nerve column and branches (not shown), while providing a degree of desired flexural bending which is an improvement over prior art immobilized spinal fusion using titanium plates and screws.
  • the use of anti-microbial additives within either of the insert and strap configurations is also contemplated.
  • a non-limiting objective is again the ability to provide a desired degree of flexural support to a spinal column location in which a previously damaged vertebrae has been removed and an artificial spacer support insert has been substituted, combined with a likewise composite supporting strap or other configured elongated member being configured to securely engaging machined locations associated with successive existing vertebrae and while permitting a limited desired degree of flex or motion mimicking the natural articulation of the spinal area, and further without damaging or otherwise compromising the proximately located spinal nerve network (not shown).
  • FIG. 2 an illustration is shown at 22 of a further configuration of exterior bracing and generally elongated structural supporting member or strap, this further exhibiting bulbous end projecting and undercut location engaging feet 24 and 26, defined in engagement with previously identified succeeding vertebrae 2 and 6 located on either side of an installed spacer insert 28.
  • a medical drill incorporating an appropriate configured and undercut creating drill bit (not shown) is provided for creating a desired undercut (also defined as an expanded inner recess) within exposed edge locations of each of the indicated natural vertebrae 2 and 6 (such as again in non-interfering fashion with the existing spinal nerve column and tributary network).
  • the construction of the insert 28 is further such that it can exhibit a combination outer softer plastic combined with a harder interior core, this intended to mimic the natural properties of existing cervical vertebrae.
  • the bracing and supporting strap 22 can also exhibit varying hardness (or modulus of elasticity) such as further contemplating softer material incorporated into the bulbous feet 24 and 26 in order to facilitate press-fit engagement within the previously machined undercut locations associated with the adjoining vertebrae 2 and 6.
  • Figure 3 is a rotated plan view of a further exterior member, or strap configuration 30, and illustrating the use of multiple engaging locations 32/34 and 36/38 (such as constructed in any suitable fashion including again but not limited to as shown for angled contact feet 14/16 and 18/20 for Fig. 1 and bulbous feet 24 and 26 in Fig. 2). In this fashion, the engagement locations secure the strap 30 to exposed (and again typically undercut) locations of adjoining upper and lower vertebrae 2 and 6.
  • An inter-disposed spacer insert 40 again exhibits such as a shortened cylinder configuration and which is positionally secured between opposing facing surfaces of the upper 2 and lower 6 vertebrae, this further defining the general boundaries of the three dimensional space to be occupied by the insert 40.
  • the insert 40 can again exhibit multi-modulus exhibiting portions (this including such as a first harder and interior plug surrounded by a second softer outer covering of specified thickness) and is further envisioned in related variants to exhibit features which facilitate adhesion or bonding of opposite end surfaces of the insert with either or both of the upper and lower situated vertebrae.
  • multi-modulus exhibiting portions this including such as a first harder and interior plug surrounded by a second softer outer covering of specified thickness
  • a further modified strap configuration is shown in which a spacer insert 42 is surrounded by a plurality of individual and thin cross sectional extending structural members 44, 46, 48 arranged in a generally pseudo-circumferential or cage extending fashion.
  • the insert 42 can (but are not required to) exhibit properties which promote artificial fusion to the adjoining vertebrae 2 and 6 (such as will be further described including the roughening of the insert spacer end surfaces to promote bone marrow growth and adhesion with the adjoining vertebrae).
  • Figure 4A is an enlarged partial view of an end-engaging location 50 also shown in Fig. 4 associated with selected exterior structural member 48 and further showing a deformable end-located pocket which, upon engagement of an insertable fastener 52 such as a screw or nail in inserting fashion through an exterior location and within the location 50, outwardly expands the end pocket (see directional arrows 54/56) to seat within recess 58 (also again shown in Fig. 4) defined within inwardly and opposing extending surfaces of the lower adjoining vertebrae 6 and 8.
  • an insertable fastener 52 such as a screw or nail
  • FIG. 5 is an illustration of a related spacer and strap configuration and illustrating a modified fastener engagement configuration, at 60, for securing at first and second vertebrae boundary locations 62 and 64 corresponding to the spaced defined between the upper pair 2/4 of vertebrae and lower pair 6/8 arranged on opposite sides of a suitable artificial spacer insert 66.
  • the strap 60 is again semi-rigid in construction and exhibits a desired modulus of flexibility with similarly configured engaging end fee 68 and 70 respectively receiving insertable fasteners 72 and 74 for outwardly expanding the same (in similar fashion to that previously shown in Fig. 4A) in engaging fashion within the interspatial boundary locations 62 and 64.
  • FIG. 6 is a perspective illustration of another variant in which a pair of further configured spacer inserts 76 and 78 are provided in successive adjoining fashion for substituting for a pair of missing vertebrae (these including the previously identified space filled by spacer insert 76 and an additional space corresponding to removed lower vertebrae 6 and its substitution by second spacer insert 78).
  • a corresponding configuration of exterior mounting supports includes additionally illustrated and alternately configured elongate members 80 and 82 for engaging upper 2 and lower 8 adjoining vertebrae at the locations indicated.
  • the upper engaging location includes vertebral undercut edge engaging fasteners 84 and 86 (with further end extending portions of the exterior members 80 and 82 optionally meeting at a common terminating location 88).
  • FIG. 7 is another illustration of a dual spacer insert arrangement, again shown at 76 and 78, this in combination with a widened and exterior supporting strap or member as further shown at 94 and which exhibits a unitary, relatively thin and widened configuration for supporting the pair of insert spacers 76/78 between upper 2 and lower 8 existing vertebrae.
  • associated end engaging feet can also include inwardly angled and undercut (or outwardly elastically deformable) portions for securely mounting the strap 94 at upper and lower locations to the existing vertebrae.
  • FIGs 8A-8D illustrate a collection of alternately configured spacer inserts and such as which complement those previously shown and described.
  • a key engageable and outwardly expandable insert according to a further variant and including upper 96 and lower 98 interconnected and respectively displaceable halves.
  • Key insert location 100 is further shown and, upon being engaged by a suitable surgeons key (not shown) incorporates a suitable mechanism interconnecting with bevel gears or the like and which, upon being rotated, exerts a bias against and actuates the halves 96 and 98 to laterally expand in the multi-directional fashion referenced by arrow 102.
  • Individual surface undercut or roughened recess patterns are depicted at 101 and 103 on opposite end engaging surfaces of the displaceable halves 96 and 98.
  • Figure 8B is an alternately configured insert 104 to that shown in Fig. 8A and again exhibiting end surface undercut or roughened recess patterns, see further at 106 and 108, for promoting bone adhesion and growth when installed between succeeding vertebrae.
  • Figure 8C is an illustration of another configuration of a key accessible and expandable insert 110 exhibiting laterally expandable wing portions, at 112 and 114, these provided in combination with fusion/growth promoting end surface undercut patterns (see upper pattern 116 and lower pattern 118).
  • a key access location is provided at 120 (similar to that identified at 98 in Fig.
  • FIG. 8D a top plan view is shown of a generally disc shaped spacer insert 122 according to another variant.
  • Figure 8E is a perspective view of a most bottom cutaway slice or portion of the insert 122, such as shown in Fig. 8D, and additionally illustrating edge extending and inwardly angled/engaging tabs 124 and 126 for mounting the spacer to an existing and succeeding vertebrae 6.
  • undercut engaging recesses can be defined in the edge extending sides of the succeeding vertebrae 6 and in order that the insert 122 be securely mounted in place, such as prior to natural bone adhesion/growth which subsequently fixes the insert in position.
  • Figure 9 is a plan view illustration in cutaway of a pair of exterior mounting members 128 and 130, these in combination with an insert spacer 140 according to a yet further embodiment.
  • an enlarged partial illustration depicts one configuration of a selected mounting member 130 which further exhibits a selected undercut engaging portion 134.
  • the engaging portion 134 exhibits an end most pseudo-serrated arrow configuration which is contributes additional restraining force when press fit into a recess previously machined in undercut fashion within the opposing end faces of the upper 2 and lower 6 vertebrae positioned relative to the spacer insert 132.
  • Fig. 9A an enlarged partial illustration depicts one configuration of a selected mounting member 130 which further exhibits a selected undercut engaging portion 134.
  • the engaging portion 134 exhibits an end most pseudo-serrated arrow configuration which is contributes additional restraining force when press fit into a recess previously machined in undercut fashion within the opposing end faces of the upper 2 and lower 6 vertebrae positioned relative to the spacer insert
  • the mounting member illustrated at 136 incorporates flexural joint locations 138 and 140 proximate end disposed and inter-vertebral space engaging portions 142 and 144 associated with the mounting member.
  • the flexural joint locations 138/140 further include such as "V" shaped or otherwise configured notches (or weakening portions) which are designed into the member 136 and which function to provide a degree of additional and desired flexural bending proximate the engaging portions 142 and 144, such as further along the mounting interfaces with the adjoining vertebrae.
  • FIG. 10 an illustration is shown of another elongate mounting member 146, this also including the features of the flexural promoting joints (or notched recesses) 148 and 150 defined within the member 146 at locations proximate inter- vertebral space engaging portions 152 and 154.
  • the engaging portions 152 and 154 as shown exhibit an additional degree of depth for inserting in supporting and shouldering fashion within and interstitial spaces defined between the spacer insert and adjoining vertebrae and, in further combination with screws 156 and 158 extending through proximate end locations of the member 146, engage previously machined apertures (or undercut patterns) associated with mating locations of the adjoining vertebrae.
  • the plastic joint exhibits desired flexural aspects which accommodate compressive forces exerted by the adjoining vertebrae, it further being understood that a degree of vertebral bone exerted pressure is desired in order to promote subsequent fusion of the strap to the spinal vertebrae.
  • Figure 11 is an illustration of another design of flexural supporting strap 160 extending between spaced apart vertebrae 2 and 6, and across a substitute insert spacer 162 according to a further embodiment.
  • Figure 12 is a rotated illustration of the supporting strap 160 shown in Fig. 11 and better illustrating both lineal end extending portions 164/166 incorporated in combination with inwardly extending and inter vertebral engaging portions 168/170. As collectively illustrated, this strap design promotes a more rigid supporting environment around the spacer insert 160 and can again utilize such as undercut engaging patterns and/or end extending and elastically deformable portions.
  • Figs. 13-17 a series of illustrations are shown of an artificial disc replacement mechanism according to a yet further preferred embodiment.
  • FIG. 13 is a cutaway side plan view in exploded fashion and illustrating a hollowed out area, generally at 171 corresponding to a previously prepared location between existing upper vertebrae 2 and lower vertebrae 6, and including a rear disc located support or column 172 and front undercut pattern defining support locations 174 and 176 (these exhibiting front located and inwardly opposing protuberances).
  • FIG. 17 the rear column 172 in combination with the front support location 174/176 can be incorporated into a single unitary component which is interconnected in three dimension and, as further shown in common referenced fashion in the height-wise cutaway of Fig. 17, collectively defines a general three dimensional interior cavity for seating an inflatable membrane (or balloon) 178.
  • a forward sealing plug 180 engageable with the flexural/inflatable membrane.
  • the plug 180 in turn includes an exterior configuration with flange extending edges 182 and 184 (see both Fig. 17 and Fig. 14A) which, upon installation within the cleaned out area, extends over the exterior edges of the existing vertebrae 2 and 6 in the manner illustrated.
  • Figure 14 is a succeeding and intermediate assembled illustration to that shown in Fig.
  • Figure 14A is an enlarged inset view taken from Fig. 14 and better illustrating the engagement of the angled barb anchors 188 and 190 projecting from the plug 180, with the aligning undercuts 192 and 194 formed in the spatially opposing vertebrae. As is further best shown in Fig.
  • the spine portion 186 establishes a generally open interior 187 (accessible from inlet location 199 of the plug 180) established by a series of interconnecting inner edges including distal proximate edge 181, spaced apart and lengthwise extending edges 183 and 183' and interconnecting proximal edge 185, the purpose for which being to provide an inner spine support for charging a polymeric settable material through the spine 186 so as to flow within the flexible and expansible membrane 178 within which the spine 186 is internally supported.
  • a syringe like component 196 is charged with the settable fluidic material 198 (such as including a two part fast reacting polymer or the like) is injected through thelet location 199 defined in the plug 180, through the opening 187 associated with the inner extending spine 186, and in order to expand the bladder/membrane 178 in the manner illustrated so as to abut the front (174/176) and rear (172) locations of the vertebral defined space, and to bias against the upper 2 and lower 6 adjoining vertebrae.
  • the settable fluidic material 198 such as including a two part fast reacting polymer or the like
  • Figure 16 is a rotated front view of the disc replacement mechanism and illustrating one non-limiting arrangement of first 188 and second 190 pairs of angularly displaceable/engageable anchors, combined with central injection aperture 199 for receiving an inserting tip of the syringe 196.
  • Fig. 17 again illustrates a top view cutaway illustration taken along line 17-17 of Fig. 16 and further illustrating the operational configuration of the disc replacement mechanism.
  • the artificial spinal disc replacement system disclosed in Figs. 13-17 possesses multiple advantages in both design and materials relative to existing systems.
  • the present invention places a plastic/metal or plastic/ceramic composite alloy material exhibiting a modulus of elasticity very similar to human cartilage in direct contact with these vertebral surface. This much more closely simulates the situation existing in a real human spine, and avoids the unwanted consequences of bone re-sorption which can otherwise occur when a hard metal is placed in direct contact with a relatively softer bone.
  • a further advantage over existing systems is that the present design does not require any shaving or reshaping of the vertebral bodies above and below the disc prosthesis, the rendering multilevel disc replacement a feasible option.
  • the procedure for installing the artificial disc system requires an anterior surgical approach similar to what is used currently for anterior discectomy and fusion procedures.
  • the native (natural) disc material is removed through an incision in the anterior longitudinal ligament, and part of the posterior longitudinal ligament is removed in conjunction with the discectomy (also termed discotomy and relating to the excavation or removal of an intervertebral disc), with the lateral columns left intact.
  • the balloon is placed into the now empty disc space and saline is injected until optimum vertebral spacing is obtained. The saline is then withdrawn and the volume noted and becomes the reference volume at which the balloon is removed.
  • the resulting artificial disc exhibits a thin shell of a plastic with a modulus of elasticity very similar to human cartilage, with the inner portion of the disc exhibiting a somewhat more viscous modulus, such as further similar to native vertebral nucleus pulposus.
  • the artificial disc system functionally operates as a real disc which is held firmly in place and presented from anterior migration using a low-profile plastic clip system that is firmly anchored in cortical bone of the vertebral body above and below the replacement disc.
  • Anti-microbial substances are integrated into the composite matrix associated with plug, balloon and settable/curable liquid and prevent bacterial contamination of the device.
  • the replacement disc also provides a lower cost item than conventional discectomy/discotomy procedures and fusion, preserves spinal motion, and generally renders prior art fusion techniques obsolete.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Neurology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Surgery (AREA)
  • General Health & Medical Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Public Health (AREA)
  • Animal Behavior & Ethology (AREA)
  • Molecular Biology (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Vascular Medicine (AREA)
  • Prostheses (AREA)

Abstract

L'invention concerne un insert d'espacement composite et un support à incorporer dans un espace défini entre des vertèbres successives. Un premier corps d'insert est constitué d'un matériau composite présentant au moins un module d'élasticité et une forme sensiblement cylindrique et est inséré à l'intérieur de l'espace, tel qu'établi entre une paire de vertèbres précédemment non successives et correspondant à une vertèbre absente. Un élément porté extérieur et supplémentaire entre en prise dans des emplacements associés aux vertèbres (précédemment) non successives et qui, en combinaison avec le corps d'insert, confère un degré de mobilité limité aux vertèbres.
PCT/US2010/036240 2009-06-02 2010-05-26 Insert d'espacement composite et support pour fournir un support vertébral intercervical WO2010141292A2 (fr)

Applications Claiming Priority (4)

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US18338309P 2009-06-02 2009-06-02
US61/183,383 2009-06-02
US12/786,088 2010-05-24
US12/786,088 US8888850B2 (en) 2007-11-19 2010-05-24 Combination spacer insert and support for providing inter-cervical vertebral support

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WO2010141292A2 true WO2010141292A2 (fr) 2010-12-09
WO2010141292A3 WO2010141292A3 (fr) 2011-05-05

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